产前超声心动图检查对胎儿先天性心脏病的诊断价值及高危因素分析

Value of prenatal echocardiography in fetal congenital heart disease and analysis of high risk factors

目的探讨超声心动图检查在产前胎儿先天性心脏病(congenital heart disease,CHD)诊断中的价值,并对影响其发生的高危因素进行分析。方法选取2020年1月至2021年1月在郑州市妇幼保健院行常规产前胎儿超声心动图检查或分娩的260例单胎妊娠孕妇作为研究对象,记录所有孕妇产前超声心动图检查结果、产后病理学检查结果、引产胎儿尸检结果,以产后病理学检查及尸检结果为诊断的“金标准”,将研究对象分为CHD组及正常组。分析产前超声心动图检查对胎儿CHD的诊断价值,回顾性分析孕妇临床病历资料,包括:年龄、产次、CHD家族史、羊水量、孕妇主动或被动吸烟史、孕妇妊娠糖尿病、孕早期感冒史、不良妊娠史等,采用单因素分析CHD发生的高危因素,并从中选取有显著差异的变量采用Logistic多因素回归分析筛选产前CHD发病的高危因素。结果产前超声心动图检查诊断胎儿CHD准确率为95.24%,特异度为99.58%,灵敏度为90.48%;单因素及Logistic多因素回归分析显示,年龄≥35岁、CHD家族史、羊水量异常、孕妇主动或被动吸烟史及孕妇妊娠糖尿病是CHD发生的独立危险因素(P<0.05)。结论产前超声心动图是筛查胎儿CHD的有效手段,其准确率、特异度、敏感度高,对于具有高危因素的孕妇,应早期进行重点筛查,采取有效的干预手段,达到优生优育的目的。

Objective To explore the value of echocardiography in the diagnosis of prenatal fetal congenital heart disease(CHD),and to analyze the high-risk factors affecting its occurrence.Methods 260 pregnant women with singleton pregnancy who underwent routine prenatal fetal echocardiography or delivery in our hospital from January 2020 to January 2021 were selected as the research objects.The results of prenatal echocardiography,postpartum pathological examination and induced fetal autopsy of all pregnant women were recorded.The"gold standard"of postpartum pathological examination and autopsy was used,those who were not diagnosed with CHD were defined as normal group,and those diagnosed with CHD were defined as CHD group.Analyzed the diagnostic value of prenatal echocardiography for fetal CHD.Retrospective analysis of clinical data of pregnant women,including age,birth,CHD family history,amniotic fluid volume,active or passive smoking history,gestational diabetes mellitus,early pregnancy history,and adverse pregnancy history,were conducted by single factor analysis of the risk factors of CHD.The variables with significant differences were selected,and the high-risk factors of prenatal CHD were screened by logistic multivariate regression analysis.Results The accuracy,specificity and sensitivity of prenatal echocardiography in the diagnosis of fetal CHD were 95.24%,99.58%and 95.00%,respectively;Univariate and multivariate Logistic regression analysis showed that over 35 years of age,CHD family history,abnormal amniotic fluid volume,active or passive smoking history of pregnant women and gestational diabetes mellitus were independent risk factors for CHD(P<0.05).Conclusion Prenatal echocardiography is an effective means to screen fetal CHD,with high accuracy,specificity and sensitivity.For pregnant women with high-risk factors,we should focus on early screening and take effective intervention measures to achieve the purpose of eugenics.